Friday, February 13, 2009

HME Stakeholders Address Medicare Fraud With Legislative Plan

During the American Association for Homecare (AAHomecare) Washington fly-in on February 11, HME stakeholders urged Congress and the Centers for Medicare & Medicaid Services (CMS) to adopt a Medicare Anti-Fraud Legislative Plan developed by AAHomecare. The legislative action plan outlines tough, effective measures to stop waste, fraud and abuse in Medicare’s home medical equipment sector.

Modern Healthcare explained that the “plan calls for mandatory site inspections of all new medical-equipment providers and companies seeking renewal of their CMS contracts; establishing more rigorous quality standards for providers; increasing penalties and fines for billing fraud; and requiring post-payment audit reviews of all new medical-equipment contractors.” To read their report of this plan visit, http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090210/REG/302109930&nocache=1.

Congressional Quarterly Healthbeat News also reported on the legislative plan, quoting president of AAHomecare Tyler Wilson, as saying, “the anti-fraud plan is the group’s attempt to help reduce Medicare fraud, which costs the $430 billion program as much $60 billion a year. DME accounts for $10 billion of Medicare spending and fraud in that sector accounts for less than $1 billion of that amount. “That has us concerned as it should have everyone concerned.”

3 comments:

Anonymous
said...

Concerning fraud in DME arena: The big problem is that Medicare's rules are so complicated and contain too much "gray areas" that there is not a single regulation that can or cannot be interpreted as fraud. For instance, some DME providers are charging patients for portable oxygen cylinders when they get over 2 cylinders a month. We have had these patients call Medicare Fraud line and report this but the patients were told by Medicare that there is no written stipulation on the number of tanks you get a month and therefore it could not be treated as fraud. CMS needs to simplify it's regulations so the patients understand the rules so they know if they are being frauded. In addition, living in the ice storm area of Kentucky, hundreds of patients were never given portable backup oxygen in the event of a power outage. These patients were being serviced by large national respiratory providers who are all accredited. We even had patients tell us they couldn't contact their oxygen provider during the storm because they were not open and patients who got an answering service told them they had not been instructed on what to tell oxygen patients when they called in. They only suggested to go to their nearest hospital. Personnally, I think accreditation will be another joke on CMS's back because it will be like the other regulations they have that are never enforced. My suggestion for fraud would be to have simplier understandable rules and enforce these rules. Don't create new rules that, again, will not be enforced. I also suggest that DME providers and patients who report fraud should be rewarded. Who knows Medicare rules better than DME providers? We can help police the rules. And finally, have the same rules for all DMEs. Why does CMS have all these accreditation companies with their own set of differing rulesthat must be followed? Again, it creates confusion and fraud becomes undefined.

As a provider of DME goods, we hear about what could be classified as fraud very frequently. This week I had a new client for diabetic shoes. I was stunned when this client asked me why I as heat molding his diabetic shoes inserts. I asked if his previous provider heat molded his inserts in the past and he stated "no, they hand them to me and tell me to change them out about every 3 or 4 months." We also perform sensory and vasucular assessments on diabetic clients (as we had interpreted CMS quality standards required this) but I have called almost every diabetic shoe provider in the area and not a one provides this service. At least 40% of these were accredited providers. So, who is right, what is right?

Diabetics spend a great deal of money on health care and I found this very interesting article on the economic costs associated with this disease. Diabetes causes great economic povertyhttp://trenchvillecity.com/diabetespoverty.htm